title: [Interest of the combination of high-sensitivity troponine and copeptin in diagnosis of non ST elevation myocardial infarction].
abstract: The diagnosis of non ST elevation myocardial infarction (NSTEMI) is very important for the emergency doctor. According to the literature copeptin, a marker of the endogenous stress, combined with troponin could be of interest in this diagnosis. The objective of the study was to investigate the association of high-sensitivity (HS) troponin and copeptine to eliminate the diagnosis of NSTEMI or unstable angina (UA) in patients arriving in Casualty with a thoracic pain. This prospective study included patients showing up at Casualty with a thoracic pain less than 12 hours old. Copeptin was measured by the BRAHMS method at admission and HS troponin was measured at admission, after 2 and 6 hours. The patients also had a follow-up phone call after 3 months. The study included 114 patients with an average age of 54.6 years. NSTEMI was diagnosed for 8.8% of them and UA for 6.1%. The patients presenting NSTEMI or UA had a copeptin rate at admission higher than the others (24.7 pmol/L versus 7.1; p < 0.002). The negative predictive value of the association of HS troponin and copeptin was 95% whereas the sensitivity was 76.5% and the specificity 78.4%. The ROC curve analysis of the copeptin results brought to light a positivity limit which would have been more successful at 10.3 pmol/L than at 14.0. The association of copeptin and HS troponin can be useful to exclude the diagnosis of NSTEMI and favours faster treatment in Casualty.
authors.affiliation: Pôle Réanimation, Urgences, Samu, CHU de la Timone, Marseille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bourgeois
authors.forename: Marion
authors.initials: M
authors.lastname: Douplat
authors.forename: Régis
authors.initials: R
authors.lastname: Guieu
authors.forename: Vincent
authors.initials: V
authors.lastname: Pradel
authors.forename: Julien
authors.initials: J
authors.lastname: Fromonot
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
authors.forename: Marc
authors.initials: M
authors.lastname: Alazia
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D003935:Diagnostic Techniques, Cardiovascular / Q000592:standards; D005260:Female; D006020:Glycopeptides / Q000032:analysis* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014336:Troponin / Q000032:analysis* / Q000097:blood
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D014336:Troponin; C048197:copeptins
keywords: NSTEMI; biomarker; copeptin; emergency; troponin